Audit Process
Audit Process

The State of New Jersey will perform pre- and post-payment monitoring to ensure that incentive payments are paid in accordance with all Federal and State regulations and policies. Providers should keep all documentation supporting attestation for 6 years in case of audit.

 

Pre-Payment Audit and Monitoring

Prior to issuing payment, all attestations will be reviewed based on information provided through the New Jersey Medicaid EHR Incentive Program Attestation Application. These reviews will include electronic inquiries and manual reviews using available data sources such as the provider, claims and encounter data stored in the New Jersey Medicaid Management Information System (MMIS) as well as other State databases and registries.

Checks will be made to verify the following:

  • The provider is enrolled in New Jersey Medicaid.
  • The provider is licensed and was licensed for the applicable time frame with no suspensions or revocations (including pharmaceutical prescribing licensure).
  • The provider is not deceased.
  • The provider has not been sanctioned
  • The provider’s Tax Identification Number (TIN) has been verified by matching with an IRS TIN
  • From a check of claims volume and the supporting information submitted, the minimum patient volume threshold is achieved.
  • No previous year payment was made, for providers claiming incentives based on adoption, implementation, or upgrading of EHR technology.
  • The provider has adopted certified EHR technology.

The federal government will perform additional pre-payment checks once the State has accepted a provider's attestation.

 

Post-Payment Audit and Monitoring

After the payment is issued, recipients will be selected for onsite inspection of the documentation supporting their original attestations and other eligibility criteria.  Original documentation to be tested will include, but not be limited to, the documents that support the patient and claims volumes, and invoices or contracts that support the adoption, implementation or upgrading of certified EHR technology.  Representatives of Mercadien, P.C. will perform these onsite inspections and report any findings to the New Jersey Division of Medical Assistance and Health Services.

The post-payment review process and timeline will be available soon.

 

Correcting Overpayments

If an audit determines that an error in payment has been made, a written notification will be created and sent, informing the provider of the intent to recover funds. The recovery process will follow current New Jersey Division of Medical Assistance and Health Services recovery practices and guidelines.